`Nonconsensual' pelvic-exams under scrutiny

June 25, 2003|By Lauren Markoe, Knight Ridder Newspapers.

WASHINGTON — University of South Carolina law professor Robin Wilson was dismayed last year when a friend told her that as a medical student, she would learn how to do a pelvic exam on an anesthetized woman.

"I was shocked," said Wilson, who specializes in health care law and bioethics.

In the year since, Wilson has combed medical journals, trying to find out more about the practice. Her conclusions, some doctors say, could lead women to worry about a problem that doesn't really exist--or at the very least has been blown out of proportion.

On June 11, she presented her conclusions at the Federal Trade Commission in Washington.

She testified to a group of lawyers, doctors and nurses that she found "a disturbing practice worldwide of using patients in teaching hospitals without their knowledge or their consent."

It often happens with pelvic exams, she said.

A woman goes to the hospital for gynecological surgery and signs a consent form. But the form doesn't specify that while she is under anesthesia, her surgeon will use her as a teaching opportunity, and allow a medical student to do a pelvic exam on her. The patient wakes up, and might never know that it was done.

The practice is not new or isolated, Wilson said, citing both British and American studies.

"How can this continue decade after decade?" she asked.

In the next several months, Wilson plans to gather a "working group" of doctors, lawyers and others concerned about the issue to help hospitals clarify their rules on consent. It could involve federal or state legislation, she said. It could mean that hospitals don't get accredited unless they strengthen their policies.

Some in medicine are worried about Wilson's campaign and the recent attention on the issue. A spate of articles in national newspapers have highlighted Wilson's cause.

In April a New York freelance journalist, Gabrielle Lichterman, formed a national group: People Against Non-Consensual Pelvic Exams. Lichterman is collaborating with Wilson on the "working group."

Dr. J.G. Reves, dean of the College of Medicine at the Medical University of South Carolina, sees an overzealousness in the campaigns. He points to one example Wilson gives, of the "vending machine" model of pelvic exams, in which medical students line up to take their turns at a vending machine. Wilson adds, quoting a medical student, "except it's a woman's vagina."

"In all the places I've been, that has never occurred," said Reves, an anesthesiologist who also has worked at hospitals at Duke University and the University of Alabama at Birmingham. "The worst thing that can happen with these kinds of hyperbole is that there would be some kind of reaction that this shouldn't happen at all."

Reves said the Medical University of South Carolina is increasingly aware of patients' privacy rights. But people also need to know, he said, that medical school is the proper time for students to learn to do pelvic exams, and to learn what abnormalities--large fibroid tumors, for example--feel like.

"You don't want to unleash on the public, at the end of medical school, doctors who hadn't learned to care for patients," Reves said.

Official policy at the hospitals at both the University of South Carolina and the Medical University of South Carolina is that no pelvic exam is done on a woman without her consent, and that she must be made aware if a medical student is participating in the exam.

Part of the problem is that doctors and those advocating for stricter consent rules don't agree on what constitutes consent.

Wilson, showing a copy of a typical consent form at the Federal Trade Commission, noted that it didn't specifically indicate that medical students would be doing pelvic exams.

She tried to calm doctors' fears about any "backlash." Other studies show, she said, that when doctors ask for permission for unnecessary medical procedures, patients, eager to aid in medical education, usually consent.

"We won't see education on the ob-gyn wards grind to a screeching halt simply because we ask women."